Breastfeeding Advice For Moms of Premature Infants

NICU fallout: It’s not about radiation

Are you the mom of a preemie who dreads pumping milk at night while the baby is in the NICU? You are not alone. Who can blame you? It’s inconvenient. It interrupts your sleep. It also interrupts your sleep! (If you noticed that repetition, you are probably NOT pumping at night.) Unfortunately, even though you are pumping every 2-3 hours during the day, your milk supply is also down…or dwindling.

But why?

Research shows there are five simple prerequisites for making milk: increased nutrition (500 calories a day is recommended, and we’re not talking just banana cream pie), increased fluid intake (10-12 glasses of water or other non-caffeinated and non-sugary drinks are best), decreased stress (I know how ridiculous that sounds with a baby in the NICU, but that’s what the experts say), lots of sleep (another laugh, since I’m telling you to get up in the middle of the night!) and pump every 2-4 hours round the clock.

While there is no solution to the fact that your milk supply follows the simple principle of supply and demand (ie, if the demand exists, the supply will follow), here is a suggestion for making the process more efficient and effective.

Set up a ‘pumping station.’ This would be ideally placed in a comfortable, well-lit area away from your partner (no need for you both to lose sleep). Before you retire for the evening, cover a plate of healthy snacks, (ie, celery and PNB, apples and cheese, or any protein/fruit/veggie combo which won’t require refrigeration overnight) and place it at your cozy spot where the breast pump is connected and RTG. Add a pitcher of iced water (or water + juice), a photo of your newborn, headphone access to soothing music, and you’ll be GTG when the alarm clock buzzes you awake.

Economy of movement

Your pumping cycle should take no more than 30 minutes. Here’s how:

1. Rise, empty your bladder & wash your hands. (In your haste, you may be tempted to skip this step , but omit it at your peril—breast infection, or mastitis— may be the painful result.)

2. Sit comfortably upright at your prepared place (good lung expansion increases milk flow), attach the pump on both sides simultaneously (find a device to facilitate this move online or at your local maternity shop), and start snacking.

3. Pump for 20 minutes, rinse your equipment, and back to bed, my pretty!

The additional early am snack will help keep your blood sugar level in a more even state, which in turn serves to increase estrogen and prolactin levels, which help elevate both your mood and your lactation supply. You should see results in a day or two.

Happy pumping!

Jenn, Reece, Nick Hall of Graham's Foundation

Dear Readers,

The following podcast is one of our most emotional interviews of 2010. The story of Nick and Jenn Hall’s journey, and Jenn’s delivering micropreemie twins, is all too common these days. “The well-meaning things people say that hurt” may sound familiar to anyone who has gone through the chaos of the time; for others, this may be an enlightening bit of news.

Listen how one family channeled their grief into a bit of comfort for other parents. The Graham Foundation “care packages” bless those who must navigate the treacherous waters of the NICU, with practical items, and wearable signs of hope.

If you or your corporation would like information on how to request a care package or donate to the Graham’s Foundation 501(c)3, please visit the website: www.grahamsfoundation.org

Nick + Jenn Hall Part 1 - Their story

Nick+Jenn Hall pt 2-about the Foundation

First, a study published by the Journal of Developmental & Behavioral Pediatrics
discussed qualitative research with 59 parents who participated in a read-aloud-to-your-preemie-in-the-NICU program. The follow-up telephone survey showed that this activity resulted in parental feelings of increased closeness to their infants.

Nothing new there.

The second item, from the journal, Cerebral Cortex, states preemies who hear their mother’s voice are able to distinguish mom’s voice from other voices, plus stimulate an emotional response. Furthermore, when preemies hear a nurse or other voice, researchers saw an entirely different ECG response, i.e., no stimulation to the emotional brain centers.

Again, this is intuitive.

Any parent, and those of us who have worked in the field of neonatology, could attest to the validity of this research… for free. Nevertheless, research is important to build an evidence-base with which to more closely plan our interventions.

Since the economy is tight, I’m glad at least some folks found work as researchers!

Annie Tao photography

Home With Your Preemie  - 5 Things Parents Should Know and Do

[Reprinted with permission from Health4Mom.org]

The first few weeks at home with a preemie can be especially trying. No matter if your preemie was born at 26 or 36 weeks, here are a few things to keep in mind

1. I Got The Thermoregulation Blues

Your preemie lacks the subcutaneous fat necessary to keep herself warm unless she is sufficiently wrapped. You don’t have to crank up the thermostat to 80F (after all, Eskimos have babies, too), but a wise parent wraps the baby in more than one layer.

For the first day or so, take baby’s temp before feeding or bathing, just as you did in the hospital. Then you will know how she reacts to what is normal environmental temperature for your household. Add or subtract layers accordingly.

Place the thermometer under the arm.

Remember: Normal = 98F-99F

Over 100F = could be a sign of illness; remove one layer and                                     check again in 30 minutes

Over 101 F= call your healthcare provider

Another hint: do NOT use a heating pad to warm the crib. Better to warm blankets by tossing in the dryer on ‘delicate’ for 5 minutes.

Recognize cold stress: cool hands/feet, sleepy, poor feeding.

Recognize heat stress: warm to touch, red, crying, may have ‘prickly heat’ rash.

2. Feeding Frenzy?

Preemies may need to eat every 2-4 hours to consistently gain weight. Do NOT let the baby sleep more than 5 hours the first few weeks, or until your healthcare provider tells you to do so.

Breastfeeding? Avoid fasting during the night to keep your blood sugar from dropping too low. Think about it: the baby is taking nourishment from you; you need replentishment!  Those decreased hormones of pregnancy can cause postpartum depression…and hypoglycemia makes it worse.

Set up a Breast Feeding Station for nights. Before turning in, arrange a plate of wholesome snacks, and a pitcher of juice and/or water at your station. (You don’t need to drink milk to make milk.)The idea is to achieve economy of movement, establish a routine and avoid the kitchen at night.

Here‘s how: go potty, wash hands; change diaper, cleanse hands; feed baby and yourself simultaneously! The whole session should take about 30 minutes.

3. Don’t Be The Rabbit

Preemies are by definition immunosuppressed. It may take up to two years to fully gain immunity to the big, wide, world we live in. Meanwhile, what ‘s a preemie parent to do? Go ahead…be the Nazi. You have our permission to blame the NICU Docs and Nurses, who implore you to guard the health of your preemie.

Here’s how:

• wash hands after every diaper change;
• limit visitors, (keep sickies away!)
• play the ‘NICU card’ for Doctor’s appointment times (early or latest in the day),
• keep up with routine vaccinations (talk to your healthcare provider about seasonal RSV and flu innoculations)
• DO NOT ALLOW SMOKING anywhere around the baby (Research shows second-hand smoke can be deadly to infants!)

4. When to call your Healthcare Provider:

• fever > 100F(axillary)
• Listless/floppy
• Excessive crying with no known cause
• Vomiting and/or Diarrhea
• Poor feeding
• Redness, swelling or foul smelling drainage from any body part
• Yellowing skin or eyes
• No stool for 48 hrs
• < 6 wets a day
• White patches in mouth

5. When to call 911 :

Baby turns blue or pale

Extreme difficulty breathing

When all else fails, do what parents have been doing for centuries: trust your gut. YOU are the best advocate for your child because YOU know her better than anyone. If something seems wrong, it probably is. Better to seek help than regret you didn’t.

Candace Campbell, MSNc, RN, has practiced as a NICU nurse, and educator for 20 years. Her documentary film, Micropremature Babies: How Low Can You Go? plus her delightful children’s books, My Mom Is A Nurse, and Good Things Come In Small Packages (I Was A Preemie),are available on Amazon.com or at:   www.CandyCampbell.com

A part of the profit from each book and film goes to The March of Dimes.

BRINGING BABY HOME / BABY-PROOFING YOUR WORLD / BABY-PROOFING YOUR HOME /PARENTING YOUR NEW BABY

Bringing Baby Home

By Candace Campbell, MSN, RN

[reprinted with permission, Health4Women magazine]

Congratulations and welcome to a new stage in your life – parenthood! Or maybe this isn’t your first baby and it’s welcome back to the magic kingdom!

In an instant, your new baby has changed you from a couple into a family. The irony of your new essence, parenthood, evokes what I like to call a babylove addiction, which in a poetic sense, may be likened to a line from the old Eagles song, “You can check out anytime you like, but you can never leave.” In a few months, you’ll look back at photos and squint to recall life before babylove.

Basic Parenting 101

But first, there’s work to do. Your transition will require intense concentration and physical endurance (tempered by angelic smiles, the softest skin, and the sweetest giggles). You’ll likely not find time to tackle these tasks after baby is born, so tackle these top four areas before your little bundle arrives:

The Trenches

• Declutter floors/stairs, secure throw rugs (for safe, late-night baby soothing).
• Install childproof locks (wise parents practice fumbling with them before they’re sleep-deprived) and night lights in strategic places.
• Place extra pillows around for comfortable infant feeding in any chair or couch.
• Practice rapid installation and adjustment of baby car seat in all vehicles.

Chow and Chores

• Make double portions of meals you enjoy, and freeze half. Cool thoroughly and label with ingredients, date and freezer life-expectancy. If using plastic bags, make sure they are specifically made for freezer use. Find food-safe practices recommended by the National Center for Home Food Preservation.
• Buy or borrow a freezer and stock it. This will save many trips when you do NOT feel like going out.
• Avoid microwaving baby’s food or milk. Microwaves work by vibrating molecules, so food and liquids heat from the inside out. The friction produces uneven heat. The contents of a bottle that may feel cool on the outside but could burn baby’s mouth and throat!
• Breastfeeding moms remember to eat a balanced diet and take in an extra 500 calories a day. Don’t forget to feed yourself at night when you’re awake feeding baby. Plan ahead. Hubby can prepare a plate of healthy snacks before bed, plus a pitcher of juice or water and keep it by your breastfeeding area. Snacking at night allows your blood sugar to stay at a more even level, which protects against low dips. Fasting causes a cascade of hormone swings and results in mood swings to match.
• Plan in advance how you will handle pet care, especially during the first few weeks after the baby’s birth.
• Use a crib tent to keep your curious cat from jumping in to snuggle with your baby; it may make for a cute picture, but it could be dangerous since many cats like to snuggle on top of their people!

Ammunition – Keep germs at bay

• Always wash your hands before touching your baby (and after every diaper change); insist that visitors do the same.
• Stock up on liquid soap, hand-sanitizer, and paper towels.
• Bar the door to anyone with a runny nose, cough, fever, or other cold/flu like symptoms. If you get sick, wear a surgical mask or a scarf around your baby. Turn your head away to cough or sneeze into your elbow or a tissue – never your hands, and wash your hands every time you use a tissue.
• Prohibit smoking in the house, and If you smoke, quit.

Expeditions

• Avoid crowds when possible (walk in the mall early or late); this is particularly important if your baby is born during the fall or winter flu seasons.
• Protect baby from the elements, especially the sun (dark skinned babies also need protection!).
• Avoid smokers.
• Let curious toddlers touch your baby’s leg or foot, as opposed to her hand or face.
• Bring more than one diaper and change of clothes in the diaper bag.

Got it? Good. You’re ready for action. Now go out there and enjoy your new baby.

About the Author: Candace Campbell, MSN, RN, has practiced as an NICU nurse and educator for 20 years. Her documentary film, Micropremature Babies: How Low Can You Go? plus her delightful children’s books, My Mom Is A Nurse, and Good Things Come In Small Packages (I Was A Preemie), are available on Amazon.com or: http://www.candycampbell.com. A percentage of the profits of each sale goes to the March of Dimes.

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Today the American Red Cross has issued a recanting of their long-held position about when a bystander must begin chest compressions. This makes intuitive sense, when compared to the recommendation since 1996, i.e.,  having to mingle spit and/or vomit with anyone, especially a perfect stranger. Eeeew. Most folks just call 911. Turns out, chest compressions completed while awaiting emergency crew arrival, makes a big difference. You always thought doing something was better than nothing, didn’t you?

So when that loud, obnoxious dude in line keels  over  and spills his popcorn, yell, “ARE YOU ALRIGHT?” feel for a pulse, and     if none, go ahead: get physical. Lock your hands together, place them at the nipple line, and push on that sucker for all you’re worth.    He  may just live to thank you. (But don’t expect an apology for making you miss the movie.)

The Las Vegas Venetian Hotel Conference Center was the place to be for nearly 3,000 of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) at the start of this month in the southwest. Outside temps  soared above triple digits, but inside we were comfortable in our climate-controlled atmosphere. I admit I didn’t venture OUT of the theme-park like atmosphere of this idyllic retreat. What a place!

As we tourists  clicked photos of the gondolas, a “real” Italian family stood posing. I inquired of their friend, the photographer, how they liked the hotel. “Fantastico!” she answered, “It’s just like Venice…only cleaner!” Then i noticed the  faint smell of chlorine wafting my way, despite the pull of garlicy-savory delicacies exuding from a nearby restaurant. I suppose that’s easier on the olfactories than the algae-cum-whatever-else- lurks in real Venetian canals?

But I digress…Did you know this is The International Year of the Nurse? (I wondered how I’m so out of touch ? It’s almost over!) AWHONN hosts reminded of that fact, and Becky Patton, immediate past President of the American Nurses’ Association (ANA: not the union,the professional association) also spoke of her part in the forming of the new Affordable Healthcare Act. How great to hear that nurses got to be a part of the conceptual and frame-building process!

One result: Soon, advanced practice nurses (APRNs) will be allowed to mastermind health clinics and receive Medicare and Medicaid reimbursement. What does this mean? (Hint: It does NOT mean that clients will no longer be able to see an M.D.)

It does mean that for the bulk of a client’s clinic visits (disease-preventing, non-life-threatening ,  ”upkeep”), the public will now have faster, easier access to healthcare by trained professionals with doctoral degrees…who just happen to be nurses. We have a feeling the public is going to be pleasantly surprised to receive  care and attention from nurses with a holistic view.

These and other HOT  topics were covered in the sweltering heat at the SMART ART conference in Las Vegas on Artificial Reproductive Technology (ART). Candy the Nurse was pleased to be one of the Round Table Discussion presenters, hosting the topic (what else?) “Psychosocial aspects of parenting a very low birth weight baby.”

Merck Pharmaceuticals sponsored this three day assembly where some of the best and brightest researchers and clinicians from the US and Canada shared updates on the state of the ART of the science of infertility.

Some nurses were invited to attend thanks to a grant from Merck. We thank you!

Participants agreed  that an ethical continuum exists  on one side, helping families longing for a child, to the other, which   stretches waaaay over to where Eugenics lurks in the midst of murky decisions. Surely, the next ten years of medical technological breakthroughs promise many changes in this young science.

The Renaissance Hotel proved a lovely and quiet refuge to study and discuss. The hotel and SMART ART staff went above and beyond to make attenders feel welcome.

Keep an eye out for interviews with several of the speakers, to be posted soon as your nurse here can eke out a few minutes to edit the audio files.

Cheers!